The Doctor Is Out

Folks in Trinidad were relieved to learn last year that the town's only hospital had obtained the services of Dr. Marci Bowers, an obstetrician and gynecologic surgeon with a distinguished resumé. The community had lacked a board-certified OB/GYN for years, and physicians of Bowers's caliber -- former chair of her department at Swedish Medical Center in Seattle, named one of "America's Best Doctors" by the American Research Council in 2002-2003 -- don't usually choose places like Trinidad to practice.

Yet Bowers had strong professional reasons for making the move. She'd been trained by Dr. Stanley Biber to take over his thriving work in sex-reassignment surgery (SRS). Over the past 34 years, Biber has performed more than 6,000 of these operations, primarily male-to-female, earning Trinidad the title of Sex-Change Capital of the World. But the eighty-year-old Biber was forced to end his pioneering efforts when he could no longer obtain affordable malpractice insurance ("Sex Change," November 27, 2003).

Bowers has other qualifications for the job that extend beyond her surgical skills. She hadn't been in Colorado long before the news began to spread that Bowers herself is a member of the transgender community; she "transitioned" from male to female in 1997 while working at a clinic in downtown Seattle. "There's a New Doc in Town, and She's One of Us!" proclaims a recent article in the Transgender Tapestry, a national quarterly magazine.

As the only SRS practitioner who's taken her own medicine, so to speak, Bowers has a special empathy for her patients' plight of feeling trapped in the wrong body. "You find out that people have these feelings at a very early age -- three, four, five years old," she says. "I don't care if you were a starting lineman for the Nebraska Cornhuskers -- whatever it is, it's probably something in the brains or the genes. It's an important journey for a certain segment of the population to take."

Bowers has a wife (who remains her "best friend," she says) and three children in Seattle, and she lives with her male partner in Trinidad. She's an ardent vegetarian who writes on her website "that the FUTURE is about the blending of race, religion, culture, food, language, sexuality and gender -- taking the best from each and making a stronger whole." She says she considered pursuing SRS as a career long before she made the leap.

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"I had thought about it when I started the process myself," she says. "There were very few surgeons doing it, and they were getting up there in years, with no one behind them. Yet there is a tremendous demand for it. You keep thinking, 'How could there be so many people?' It's an amazing number."

Since taking over from Biber last July, Bowers has seen her own patient numbers soar; she's now performing three or four SRS operations a week, the same as Biber's pace in his heyday. (She also delivers babies and performs gynecological work.) Although a male-to-female surgery used to take her almost six hours, she's since got it down to just over three hours. At the same time, she's worked hard to refine Biber's approach to the penile inversion technique, which involves scooping out a cavity from the perineum and lining it with skin from the penis to fashion a vagina, with scrotal tissue forming the labia.

"Initially, I did an exact copy of what Biber did," Bowers says. "Then I started adding my changes. That was not easy. Not everything worked the way I thought it might. But I had seventeen years of experience in gynecology, and I wanted it to be more than what it was."

Candidates for the operation must live in the clothing of the opposite gender for a year, undergo psychological counseling and take hormones; they usually receive breast implants, a tracheal "shave" (to minimize the Adam's apple) and other cosmetic work as well. Insurance doesn't cover such procedures, and Bowers's posted price for the basic male-to-female surgery is $14,000, hospital and anesthesia costs included. While she does some surgeries related to the female-to-male operation, such as testicle implants, she has elected not to perform phalloplasty -- the construction of a penis.

"It's not a real functional surgery," she says of the female-to-male genital surgery. "It just doesn't look all that good and doesn't work all that good, so I'd just as soon not do it."

But her attendance at transsexual conferences has taught Bowers that the female-to-male patients often have a less agonizing transition period than transgendered women. "The surgery is worse, but they pass much, much better," she notes. "Once your voice drops and you get a little facial hair, you're treated as a male."

Bowers says that many of her patients still face ostracism and possible loss of employment after their surgery: "As a medical condition, I think there's a good deal more understanding of it now. I get calls from gynecologists around the country, and many primary-care physicians have seen at least one person in this situation. But as the movement's grown, it's come under the crossfire of the religious right. People have used religion to defend their bigotry, and it's resulted in more hardship for people."

Although her own background is a strong plus with some patients, others initially regard Bowers with some skepticism. "It's like your kid brother doing well for himself," she says. "There's a belief that there's so much personal tragedy in this kind of journey that you couldn't possibly come out of it unscathed. They feel I must have a few thorns in my body, too. Then they meet me, and I'm pretty normal, and that surprises them."

Bowers says another transgendered doctor is currently finishing her plastic surgery residency in Philadelphia and has expressed interest in an SRS practice. Other specialists have been building practices in cities ranging from Montreal to Scottsdale, offering an increasing array of services, including facial feminization surgery. But the demand for the procedures continues to outpace the available number of qualified surgeons, she says.

"I've actually gotten an e-mail from somebody in Iraq," Bowers says. "I could only offer advice from afar. They're certainly not going to have much support if they do anything there."